Title:Telmisartan in the Management of Diabetic Nephropathy: A Contemporary View
VOLUME: 8 ISSUE: 3
Author(s):Pitchai Balakumar, Harish K. Bishnoi and Nanjaian Mahadevan
Affiliation:Department of Pharmacology, Cardiovascular Pharmacology Division, Institute of Pharmacy, Rajendra Institute of Technology and Sciences (RITS), Sirsa-125 055, India.
Keywords:Telmisartan, AT1 receptor blockade, PPARγ partial agonism, Diabetic nephropathy, Renoprotection
Abstract:Diabetic nephropathy, a complex disorder with heterogeneous etiologies, remains one of the most threatening
diseases worldwide. There were around 177 million people with diabetes mellitus worldwide, and it has been estimated to
be increased to 360 million by 2030. Given that about 20-30% of these people develop diabetic nephropathy, the present
treatment protocols primarily aim for an efficient glucose and blood pressure control to arrest the initiation and progression
of diabetic nephropathy. The treatment of diabetic nephropathy near the beginning at microalbuminuria stage with
angiotensin-II-AT1 receptor blockers (ARBs) improves blood pressure control and halts disease progression of diabetic
nephropathy. In fact, ARBs exert renoprotective effects independently of their blood pressure lowering effect, as they
have direct defensive action on the diabetic kidney. Indubitably, it would be better if an ARB has both glucose-lowering
and blood pressure controlling potentials efficiently. Intriguingly, telmisartan has such possessions considering its dual
role of AT1 receptor blocking action and peroxisome proliferator-activated receptor gamma (PPARγ) partial agonistic
property. The additional PPARγ agonistic potential of telmisartan could make it a distinctive intervention in the ARB
class to prevent the progression of diabetic nephropathy through activation of PPARγ-mediated insulin sensitization, and
renal anti-inflammatory and anti-oxidant actions. Indeed, telmisartan reduced insulin resistance and glucose intolerance,
and halted the progressive renal dysfunction associated with diabetic nephropathy by inhibiting the incidence of albuminuria,
and preventing the progression of glomerulosclerosis, renal interstitial inflammation and fibrosis. This review will
discuss the current status of therapeutic potentials of telmisartan in treating diabetic nephropathy.
